Teaching Medical Educators How to Teach Communication Skills: More than a Decade of Experience.

OBJECTIVES: Although opportunities exist for medical educators to gain additional training in teaching, literature that describes how to teach educators to teach communication skills to trainees is limited. The authors developed and evaluated a faculty development course that uses didactics, demonstration, drills, and role-play in a small-group format. METHODS: The course has been offered through the Institute for Clinical Research Education at the University of Pittsburgh for almost 15 years. Course effectiveness was evaluated with a survey of 62 clinicians who completed the course between 2003 and 2012. RESULTS: The response rate was 85%. A total of 98% would recommend the course to a colleague and 98% indicated the course was effective at developing teaching techniques. Their use of standardized patients, teaching in small groups, and role-play increased as a result of participation in the course. A total of 70% went on to formally teach communication skills at various medical education levels. CONCLUSIONS: This structured course effectively taught participants how to teach patient-doctor communication in both classroom and clinical settings. The majority put these techniques to use in formal settings. This course also provided educators with the skills necessary to meet the growing needs of training programs charged with teaching the next generation of providers to effectively communicate with patients. The description presented can serve as a framework for faculty development in teaching communication.

Imaging brain amyloid in nondemented young adults with Down syndrome using Pittsburgh compound B.

Down syndrome (DS) is one of the most common causes of intellectual disability. Although DS accounts for only 15% of all individuals with intellectual disabilities, adults with DS account for approximately 60% of individuals with intellectual disabilities and Alzheimer's disease. This is thought to be because of overproduction of the ß-amyloid (Aß) protein due to trisomy for the Aß precursor protein gene on chromosome 21. Pittsburgh compound B (PiB) is a noninvasive in vivo positron emission tomography tracer used to image amyloid deposition in living humans. Studies using PiB have shown an age-dependent asymptomatic amyloid deposition in more than 20% of the cognitively normal elderly population. Presymptomatic carriers of presenilin (PS-1) and Aß precursor protein gene mutations who are destined to develop Alzheimer's disease also show preclinical amyloid deposition. This report describes a pilot study involving the use of PiB in seven adults with DS (age: 20-44 years). Compared with objective cutoffs for amyloid positivity in older non-DS cognitively normal control subjects, only two of the seven DS subjects (age: 38 and 44 years) showed increased PiB retention. The remaining five subjects aged between 20 and 35 years showed no detectable increase in PiB retention. Interestingly, the two subjects who showed elevated PiB retention showed a striatal-predominant pattern similar to that previously reported for PS-1 mutation carriers. These results demonstrate the feasibility of conducting PiB positron emission tomography scanning in this special population, and suggest a link between Aß overproduction and early striatal deposition of fibrillar Aß.

A 7-year-old child with Down syndrome and disruptive behaviors.

CASE: Steve is a 7-year-old child with Down syndrome who was referred to the Developmental and Behavioral Pediatrics Clinic for increasing hyperactivity and disruptive behaviors. He is followed closely for complex congenital heart disease, oxygen dependent pulmonary hypertension and chronic lung disease. He is accompanied by his mother who, while greeting the staff with a smile, apologizes as Steve attempts to get out of his stroller. His mother reports that the pulmonologist requested an evaluation of Steve's disruptive behaviors during recent clinic visits. She states that new people and unfamiliar surroundings cause Steve to become "over-stimulated." He moves around the room, plays with everything available for brief moments, is difficult to examine and difficult to redirect. His mother states that these behaviors are limited to the doctor's office. However, she is even more concerned about his behavior since his recent discharge from the hospital 8 days prior to the clinic visit. Steve was hospitalized for two weeks with a febrile illness associated with pulmonary edema. He required an increase in oxygen and maintenance of his usual medications: digoxin, furosemide, aldactone, an inhaled steroid, levalbuteral, and potassium chloride. During the hospitalization, sildenafil was increased to manage pulmonary hypertension and lorazepam was prescribed for disruptive behaviors. Steve's mother observed that the increase in sildenafil was associated with a significant change in behavior including difficulty following directions, impulsivity and over activity. She worries that he will hurt himself accidentally. Behavioral techniques that were previously helpful at home are no longer are effective. As Steve's mother describes the behaviors, she began to cry. She recently adopted Steve, whom she has cared for since his birth but now confides, "I may have made the wrong decision." She also cares for her biological adult daughter who has Down syndrome. Steve has remained home for several weeks as a result of his physician's recommendations in order to prevent another infectious illness. At home, his mother is struggling with his behaviors and talks about her increasing sense of frustration and anxiety. At the clinic visit, Steve is an active child with physical features typical of Down syndrome. He is wearing a nasal canula with a protective plastic cover, acyanotic and breathing comfortably. He looks at a book and colors on the pages briefly but then loses interest. Steve is in constant motion and interested in exploring the examination room. He particularly likes to climb onto the examination table and look at a mirror while playing with various objects. Steve has limited responsive to redirection. He speaks only a few single words, but he understands simple directions.

Current dilemmas in Down syndrome clinical care: celiac disease, thyroid disorders, and atlanto-axial instability.

This study will discuss our current understanding of celiac disease (CD), thyroid disorders, and atlanto-axial instability, three important areas of medical management in individuals with Down syndrome (DS). In this study, we highlight our current knowledge, as well as what we need to study in order to gather the necessary data to refine the empirically based screening protocols which are now in place.

Cuidados de saúde para indivíduos com Síndrome de Down

Guia de cuidados médicos preventivos para pessoas com síndrome de Down disponibilizado pela organização não governamental Portal Sindrome de Down. Fornece informações sobre o guia, indica exames e procedimentos recomendados conforme a faixa etária do paciente e a especialidade médica.